Permit CITY T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 -10007
,473111( 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/6/2006
PARCEL: 1S135AB-03400
SITE ADDRESS: 10260 SW GREENBURG RD 600 ZONING: C -P
SUBDIVISION: LINCOLN CENTER /LINCOLN TOWER LOT: 014 JURISDICTION: TIG
Project Description: Limited energy for HVAC
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EQUITY OFFICE PROPERTIES TRUST AMERICAN HEATING
ONE SW COLUMBIA ST #300 1339 SW GIDEON ST
PORTLAND, OR 97258 PORTLAND, OR 97202
Phone: Contact #: PRI 503 239 - 4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount
[TAX] 8% State Surchar€ 4/1/2006 $6.00
[ELPRMT] ELR Permit 4/1/2006 $75.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to foll. • - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through (BAR 952 - -41 . I. You may obtain copies of these rules or direct e. • estions to OU ► C at 503- 246 -6699.
Issued B . ��� J 4 . __ ,!r Permittee Signatu 41111.■
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
. •
- FOR OFFICE USE ONLY -
„ A / 10 4 .
City of Tigard Receiv / Pennit N ed _ •
A00 Date/By: ffo 4111,0 I) o.: E ,... A , 00 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 04' AA A
9v 4 0401 tb Date/B : Other Permit:
Inspection Line: 503.639.4175 tt ' 1 I Date Ready/13y: Jur,....is: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: •-• Supplemental Information
•
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,, atVoItitMFV145*rAa-tt-C*, r'44 ii4PP-1°-WrZiWariP:4:NENti•*4k; ;Ag-eiT:,::::111;.,.:
'-' 1 ` , 2g,,,t - •at.:,,, ,,,,b,i - &,. ,..•_. • 'ke ,,,,,,, ■ ,, r - ,, A.'` ,,,,,,,, ,,-*'''.'''"'''',''''''"' ''''"" ''''' ' - " - - ' ' --' '
0 New construction DIA Addition/alteration/replacement Please check all that apply:
0
0Service over 225 amps, comm'l 0Hazardous location
Demolition Other: 0
Oservice over 320 amps - rating 0Buildng over 10,000 s ft.,
of 1- and 2-family dwellings 4 or more new residential
D 1- and 2-family dwelling Nt Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
OBuilding over three stories 11Feeders, 400 amps or more
0 Multi-family D Master builder 0 Other:
00ccupant load over 99 persons CIManufactured structures or
'j,„ . 1 : 74 4 - ?45% , VWTRreVallbr '- .4aVaarr --- i- --- EVVR - r , V DE plan RV park
00ther:
0Health-care facility
Job no.S066 - .1 Job site address: 1 U U0 O S 03 CIANezit coCce3 ej
Submit 2 sets of plans with any of the above.
City/State/ZIP: 1 0 ,a__ Q7'D-6-t) The above are not applicable to temporary construction service.
( ---;',1i..-,-,.:,',1:,--•:•,:::-;....,n
aferinnIEF 1.01.:•4f• • ' l;., '.. •
Suite/bldg./apt. nlot . --joi Project name: \AN:Q < - cc( -1
Description I Qty. I Fee. I TOW **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or legs 145.15 4
Subdivision: . Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 . 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
.__ , ,, , , „. _,„,„,,_ „„,, Limi
' ted energy, non-residential 75.00 2
.,.; .: ..tri Each manufactured or modular
I \ 1 Od■ r e.A 6-Cei:6 StR,' dwelling, service and/or feeder 90.90
Services or feeders installation, alteration, and/or relocation 2 _
' , 0,_56A - 4A/ 200 amps or less 80.30 2
VSZOI 'AftWe . : 7i ' ' 11WW.E 1 g4 7 4Wi.P.:. " ZiWIRM. int -„.,'
---,,, . . • 201 amps to 400 amps 106.85 2
: ."-- ; ,,,,..„.,...,..,„.....-.. ,,, , „ . „,,.."., -,,,,.,,,,,„,w,:itay. - ,,, ,.,-- -,;',. . 0 c, `'- ';'.-=•,,, , d ''''' ' ''''' ''‘ • ' ' 401 amps to 600 amps 160.60 2
Name: , 601 amps to 1,000 amps 240.60 2
Address:
Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
"" ' ' ' ' " '"''''''''' r' " '',?'• I'Y.••= -
A. Fee for branch circuits with
-- 7 , 0r - p.*:a7 VE .. 7:17- ::TTAFS 4 ,12 ',E 4. te , 2 ' ' 1 . - • ,-
service or feeder fee, each
. 6.65 2
Business name: l--TNIX L can . • sli 01 -11c , branch circuit ,
B. Fee for branch circuits
Contact name: r--- •■t ( t 0,41.. Sa(2--6‘ without service or feeder fee,
46.85 2
each branch circuit
Address: 1 7 66 GLQ-6Y1 Each add'l branch circuit 6.65 2
City/State/ZIP: " k)-0■(---(..0,_,(\a it 0 Q_ C11 a o'?- Miscellaneous (service or feeder not included) _
Pump or irrigation circle .40
Phone: ( 15
) • y ), f1 4-t,„ 00 I Fax: : 5) __.-1,--.3% 53 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
energ p anel alteration f#010410MNAWROMPOOKWAPNWERNEMPA051 gy.13 e or
, . '
extension. Des i Page 2 2
Business name: pt-lywAaun 4--eat,615 I il_c" , 141/ ef •
t
Address: f - 3 39 S E (.911 ciszzvi Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: ----Pci q7 -)-0D- Investigation per hour (1 hr min) 62.50
\, _
, ,
Phone ciF )..- ( 4F (r 3 .-
0 a 1-
j 1 in
( 'ax: Industrial plant per hour 73.75
0 6
MelitiNEVIVO, SC.91. .11MM.Railakil.
CCB Lic.: ''' 3 i,..3c Electrical Lic.: ? CRC Suprv. Lic.: DCNO LOS Subtotal
Suprv. Electrician signature, required ( D ( j A ,,i. e,..: Plan review (25% of permit fee)
,
U State surcharge (8% of permit fee) ee „
Print name: -- T , .Ie \J Q JA k 6 wit
-...
- ■„.1P1.1151141, 0 ,
Date:
TOTAL PERMIT FEE
A i) N
Authorized signature: ,,, 6(4. This permit application expires if a permit is not obtained within 180
days after it has been accepted-as complete
Print name: ,," ,6 Date: ' 3 --6 --6 6 . Fee methodology set by Tr-County Building Industry Service Board
**Number of inspections per permit allowed.
i: \ Building \Permits \ELC-PcrmitApp.doc 12/03 440-4615T(10/02)COM/WEIS
o3/MAR. 14. 20062; 4: 10PM1359815032397038 CITY OF TXGARD NO. 0090 P. 2
:16 -ree - -- 71 Z .6
Building Division
1 ,ti "
,� 1 ' Request for Permit Action or Refund
_ REGENED
Ci of T'acrd
TO: CITY OF TIGARD MAR 15 2006
Permit System Administrator
13125 SW Hall Blvd,, Tigard, OR 91223 CITY Of "i'IUFil
Phone: 503.718.2430 Fax: 503.598.1960 www.tigau'd- or.goI3$ D(j DIVISION
FROM; ❑ Owner t2f Applicant ❑ Gantractor ❑ City Staff ' , !c°
(check one) .,,, / ; ? . 40. , k / � .
Name; 1 Yn ri ccx ` . Inc r 1, ° '
(B ks usinc or Individual) � � � G r `V _ ' - f
V 0 I D Mailing Address: \ 3_ p , e �� ci `' ,
.7 \ 2-679-A1 " (6- City/State/Zip: PO )l+''s.GJ A , t C' `f a () g-
y e Phone No.: Jf - dN q -!-4 (Odv
m i.__ (PLEASE TAKE ACTION FOR THE I M(S) CREC D (
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES. tO ° Io
REMOVE CONTRACTOR FROM PERMIT (do loot cancel permit).
Pmt #: 53— � — 10.297 --45 0-°
Site Address or Parcel P. . v SUS C1 QTl b A . ��• +." e�
Project Nam: 1 n � ui 0 d c e
Subdivisio>a Name: Lot #:
•
EXPLANATION: 6A -M ^ C in 1 ,1-4 I � ( ik-
Signature: 811 Ma Date: 3_- _ q
Print Nance: 'EMO GL a , D .( c
' ,amid Poticy
L 'Mc Building Official may authorixo the refund ot-
a) any fct which was erroneously laid or collccscd.
6) cot morn than so pereaat ofthe permit fee for issued permits prior to any inepeedon raquesl&
c) not more than b0 percent of plan review too when an application is canceled before any plan (review effort has been expended.
2. Xteftnde will be mined-to the original Payer Lathe same method in whim peymeut urea received.
1:0 1 O1 1 l -..1:4,>N1..`
Rte to S Admen: Date / B „Ii Rte to Bid; Ae:lmin: Date /d P B ,a
Refitad Processed: Date Iffige, B invoice ?massed: Date B
Permit Canceled: Date /r e B AAA! Parcel T. _ Added: Date B
Receipt #O( - /t� Date YAKo6 Method C ",9 Amount S c/, 0 =7
L• Build&ag\Forms'RogPet hActioa -B dg.doc 0120/06